<form>
    <table width="270" border="0" height="90" background="imagenes/bg_log.png">
        <tr>
            <td width="20">&nbsp;</td>
            <td width="65" rowspan="2">Ejemplo:</td>
            <td width="165" rowspan="2"><input type="text" name="men_txt" value="Esto es ejemplo" /></td>
            <td width="20">&nbsp;</td>
        </tr>
        <tr>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
        </tr>
        <tr>
            <td height="32">&nbsp;</td>
            <td colspan="2" align="center"><input type="reset" value="Limpiar" /></td>
            <td>&nbsp;</td>
        </tr>
    </table>
</form>